Shift to community-onset Clostridium difficile infection in the national Veterans Health Administration, 2003-2014 - 27/03/18
, Mary Jo V. Pugh, PhD, RN c, d, Kenneth A. Lawson, PhD a, Eric M. Mortensen, MD, MSc e, f, Jim M. Koeller, MS a, b, Jacqueline R. Argamany, PharmD a, b, Christopher R. Frei, PharmD, MSc a, b, cHighlights |
• | C. difficile infection (CDI) types were studied in U.S. veterans from 2002 to 2014. |
• | Healthcare facility-onset CDI was the predominant CDI type. |
• | The proportion of patients with community-associated CDI increased in recent years. |
• | Healthcare facility-onset CDI patients had higher rates of severe CDI and mortality. |
Abstract |
Background |
Clostridium difficile infection (CDI) occurs frequently in inpatient settings; however, community-onset cases have been reported more frequently in recent years. This study evaluated hospital-onset and community-onset CDI in the national Veterans Health Administration (VHA) population over a 12-year period.
Methods |
This was a retrospective cohort study of all adult VHA beneficiaries with CDI between October 1, 2002, and September 30, 2014. Data were obtained from the Veterans Affairs Informatics and Computing Infrastructure. CDI was categorized into community-associated CDI (CA-CDI); community-onset, health care facility-associated CDI; and health care facility-onset CDI (HCFO-CDI). Each type was described longitudinally and was assessed as an independent risk factor for health outcomes using multivariable logistic regression.
Results |
Overall, 30,326 patients with a first CDI episode were included. HCFO-CDI was the predominant type (60.2%), followed by CO-HCFA-CDI (20.6%) and CA-CDI (19.2%). The proportion of patients with HCFO-CDI decreased from 73.5% during fiscal year 2003 to 53.2% during fiscal year 2014, whereas CA-CDI increased from 8.3% to 26.7%. HCFO-CDI was a positive predictor of severe CDI (odds ratio [OR], 1.71; 95% confidence interval [CI], 1.59-1.84) and 30-day mortality (OR, 1.46; 95% CI, 1.32-1.61), but a negative predictor of 60-day recurrence (OR, 0.41; 95% CI, 0.37-0.46).
Conclusions |
HCFO-CDI was the predominant CDI type. The proportion of patients with CA-CDI increased and HCFO-CDI decreased in recent years. Patients with HCFO-CDI experienced higher rates of severe CDI and mortality.
Le texte complet de cet article est disponible en PDF.Key Words : Epidemiology, Healthcare-associated infection
Plan
| Funding/support: Supported, in part, by an American College of Clinical Pharmacy Research Institute Futures Grant and was supported with resources and the use of facilities at the Audie L. Murphy Memorial VA Hospital, San Antonio, TX. The contents do not necessarily represent the views of the US Department of Veterans Affairs or the US government. Support was also received from the National Institutes of Health/National Institute on Aging San Antonio Claude D. Pepper Older Americans Independence Center (grant No. 1P30AG044271-01A1) and the National Institutes of Health/National Center for Advancing Translational Sciences (grant No. UL1 TR001120). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. |
|
| Conflicts of interest: None to report. |
Vol 46 - N° 4
P. 431-435 - avril 2018 Retour au numéro
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